Diagnostic value of Lipoarabinomannan antigen for detecting Mycobacterium tuberculosis in adults and children with or without HIV infection

ObjectivesEven today, tuberculosis (TB) remains a leading public health problem; yet, the current diagnostic methods still have a few shortcomings. Lipoarabinomannan (LAM) provides an opportunity for TB diagnosis, and urine LAM detection seems to have a promising and widely applicable prospect.Design or methodsFour databases were systematically searched for eligible studies, and the quality of the studies was evaluated using the quality assessment of diagnostic accuracy studies‐2 (QUADAS‐2). Graphs and tables were created to show sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), the area under the curve (AUC), and so on.ResultsBased on the included 67 studies, the pooled sensitivity of urine LAM was 48% and specificity was 89%. In the subgroup analyses, the FujiLAM test had higher sensitivity (69%) and specificity (92%). Furthermore, among patients infected with human immunodeficiency virus (HIV), 50% of TB patients were diagnosed using a urine LAM test. Besides, the CD4+ cell count was inversely proportional to the sensitivity.ConclusionsUrine LAM is a promising diagnostic test for TB, particularly using the FujiLAM in HIV‐infected adults whose CD4+ cell count is ≤100 per μl. Besides, the urine LAM test shows various sensitivities and specificities in different subgroups in terms of age, HIV infection status, CD4+ cell count, and testing method.     

皮肤黑色素瘤中PITX1表达及其与临床病理特征和预后的关系

目的研究垂体同源框1(PITX1)表达与皮肤黑色素瘤(CMM)临床病理参数的关系,并探讨PITX1表达与CMM预后之间关系。方法2012年1月2014年2月在本院诊治的CMM患者43例为研究对象,选取同期在本院进行整形手术的皮肤正常者37例为对照。采用免疫组化法检测不同皮肤组织PITX1表达水平,分析PITX1表达与CMM临床病理参数及预后之间的关系。结果PITX1在CMM组织中阳性表达率与良性皮肤增生组织比较明显较低,差异有统计学意义(P<0.05)。PITX1相对表达水平与患者肿瘤溃疡情况、坏死情况、Breslow厚度、Clark分级、肿瘤发展进程(TNM)分期、淋巴结转移等有关,差异均有统计学意义(P<0.05)。Kaplan-Meier生存曲线分析表明,PITX1阳性表达者3年存活率显著高于PITX1表达阴性者(90.91%vs.46.88%,P<0.05)。COX分析结果表明,PITX1、TNM分期是影响CMM患者预后的独立危险因素(HR=2.157,95%CI为1.168~3.983,P<0.05;HR=2.097,95%CI为1.073~4.098,P<0.05)。结论PITX1在CMM组织低表达,是影响CMM患者预后的独立危险因素。